经过有限培训的住院医师进行基础重症监护超声心动图检查的治疗效果。

IF 5.7 1区 医学 Q1 CRITICAL CARE MEDICINE
Marine Goudelin, Bruno Evrard, Roxana Donisanu, Céline Gonzalez, Christophe Truffy, Marie Orabona, Antoine Galy, François-Xavier Lapébie, Yvan Jamilloux, Elodie Vandeix, Dominique Belcour, Charles Hodler, Lucie Ramirez, Rémi Gagnoud, Catherine Chapellas, Philippe Vignon
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引用次数: 0

摘要

背景:目的:评估经过有限培训的超声心动图新手(住院医师)和作为参照的专家根据基本重症监护超声心动图得出的治疗建议之间的一致性。次要目标是评估操作员对简单临床问题的回答与基本二维测量之间的一致性:这项观察性、前瞻性、单中心研究在内外科重症监护病房进行,为期 3 年。研究对象为需要进行经胸超声心动图(TTE)检查的急性循环和/或呼吸衰竭的成人患者。每名患者的 TTE 均由一名经过短期培训的超声造影新手和一名超声造影专家在 1 小时内以随机顺序独立完成。每位操作者都要回答标准化的简单临床问题,然后根据预先设定的算法提出治疗策略:住院医师平均为 244 名患者(156 名男性;年龄:63 岁 [52-74];SAPS2:45 [34-59];182 名(75%)机械通气患者)进行了 33 次 TTE 检查。住院医生和经验丰富的操作员的治疗建议之间的一致性从良好到优秀。在建议输液、肌注或血管加压支持方面,一致性极佳(所有 Kappa 值均大于 0.80)。在考虑体液负平衡的指征时,观察者之间的一致性仅为中等(Kappa:0.65;95% CI 0.50-0.80),因为住院医师对 23 名患者(9.5%)建议使用利尿剂,而他们的同行则对 35 名患者(14.4%)提出了同样的建议。对简单临床问题回答的总体一致性也从良好到优秀。测量心室和下腔静脉大小的类内相关系数超过了 0.75:结论:旨在获得重症监护超声心动图基本水平的有限培训项目,能让超声心动图新手在提出治疗干预建议时,与经验丰富的操作者达成良好至卓越的一致。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Therapeutic impact of basic critical care echocardiography performed by residents after limited training.

Therapeutic impact of basic critical care echocardiography performed by residents after limited training.

Background: The objective was to assess the agreement between therapeutic proposals derived from basic critical care echocardiography performed by novice operators in ultrasonography after a limited training (residents) and by experts considered as reference. Secondary objectives were to assess the agreement between operators' answers to simple clinical questions and the concordance between basic two-dimensional measurements.

Methods: This observational, prospective, single-center study was conducted over a 3-year period in a medical-surgical intensive care unit. Adult patients with acute circulatory and/or respiratory failure requiring a transthoracic echocardiography (TTE) examination were studied. In each patient, a TTE was performed by a resident novice in ultrasonography after a short training program and by an expert, independently but within 1 h and in random order. Each operator addressed standardized simple clinical questions and subsequently proposed a therapeutic strategy based on a predefined algorithm.

Results: Residents performed an average of 33 TTE studies in 244 patients (156 men; age: 63 years [52-74]; SAPS2: 45 [34-59]; 182 (75%) mechanically ventilated). Agreement between the therapeutic proposals of residents and experienced operators was good-to-excellent. The concordance was excellent for suggesting fluid loading, inotrope or vasopressor support (all Kappa values > 0.80). Inter-observer agreement was only moderate when considering the indication of negative fluid balance (Kappa: 0.65; 95% CI 0.50-0.80), since residents proposed diuretics in 23 patients (9.5%) while their counterparts had the same suggestion in 35 patients (14.4%). Overall agreement of responses to simple clinical questions was also good-to-excellent. Intraclass correlation coefficient exceeded 0.75 for measurement of ventricular and inferior vena cava size.

Conclusions: A limited training program aiming at acquiring the basic level in critical care echocardiography enables ICU residents novice in ultrasonography to propose therapeutic interventions with a good-to-excellent agreement with experienced operators.

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来源期刊
Annals of Intensive Care
Annals of Intensive Care CRITICAL CARE MEDICINE-
CiteScore
14.20
自引率
3.70%
发文量
107
审稿时长
13 weeks
期刊介绍: Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.
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